Infections

NON-SPECIFIC URETHRITIS

Non-specific or non-gonococcal urethritis (NSU or NGU) as it is sometimes known is the commonest acute bacterial sexually transmitted infection seen in UK Genito-Urinary Medicine clinics. It only occurs in men.

It is caused by several bacteria including Chlamydia, Ureaplasma and Mycoplasma. It can also be caused by viruses such as the adenovirus and Herpes virus, parasites ( Trichomonas) and even allergic reactions to soaps etc although this latter cause is rare. By definition it is not caused by Gonorrhoea and cannot occur in women, although when the bacteria causing NSU are transmitted to women they can cause a variety of symptoms including Pelvic Inflammatory Disease.

It is passed on through unprotected vaginal, oral or anal sex although it can also be transmitted when a condom splits or tears during use. If you are worried about acquiring NSU but have no symptoms it is best to wait for 7-10 days after a particular exposure before being tested.

The symptoms include a burning sensation when passing urine and urethral discharge. 50% of men are asymptomatic or have no symptoms.

At the clinic, NSU is diagnosed by taking a urethral swab and examining it under the microscope. This is usually a quick procedure. It is important for a man to NOT pass urine for three to four hours prior to having such a swab taken. This is because every time a man urinates, the urine washes any bacteria present out of the end of the penis. The bacteria need a certain amount of time to re-accumulate so that they can be detected by a swab.

If NSU is diagnosed then the treatment is a simple course of antibiotics, usually Doxycycline. There are other alternatives such as Azithromycin. It is easy to eradicate (cure) this infection however, it is vital for the sexual partner(s) of a man with NSU to be treated and for the man himself and his partner(s) to abstain from sex during the treatment period otherwise there is a high risk of the infection persisting.

A follow-up visit for a test is not usually recommended unless you have persistent symptoms at the end of treatment. In that case, a repeat swab is taken and if this shows persisting NSU then re-treatment with a different class of antobiotics is likely to be prescribed.. It is worth noting that the majority of men who complete their initial antibiotics AND abstain from sex are able to completely clear the infection.

If the infection persists or is left untreated then several complications may arise. These include epididymo-orchitis (infection of the testicles and spermatic cords), acute prostatitis (infection of the prostate), subfertility and occasionally Reiter's Syndrome (an immunological phenomenon with conjunctivitis and joint pains). The likelihood of all of these can be greatly reduced by prompt treatment of any infections.

After NSU has been successfully treated it is possible for it to recur. This is either by re-infection from a sexual partner or as a recurrence triggered by a number of factors including drinking excessive alcohol. Often, men seem to have "recurrent NSU" and in these cases it is likely that the inflammation seen under the microscope does not necessarily represent new infections. Treatment of the sexual partners of men with NSU needs to be considered on a case-by-case basis as drug treatment will sometimes but not always be necessary.

The most important aspects of prevention of NSU are limiting the number of sexual partners you have and using condoms for sex. It is worth bearing in mind that condoms limit but do nor eradicate risk since they can split or tear especially if not used properly. Infections can be easily passed on if genital secretions come into contact with a partner prior to penetration i.e. through mutual masturbation.